Janssen M P, van Tilborgh A J W, de Vooght K M K, Bokhorst A G, Wiersum-Osselton J C
Transfusion Technology Assessment Unit, Sanquin Research, Amsterdam, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Vox Sang. 2018 Feb;113(2):143-151. doi: 10.1111/vox.12614. Epub 2017 Nov 9.
Despite increasingly meticulous haemovigilance reporting throughout the world, a systematic assessment of the cost of transfusion reactions is still lacking. This is partly caused by the fact that such an assessment requires a subjective expert assessment of the additional costs linked to the adverse reaction. Data on the cost of transfusion reactions could support decision-making regarding blood transfusion safety measures.
Thirteen experts from nine hospitals were asked to estimate the additional care required following various types of transfusion reactions. Additional care was quantified as the proportion of reactions requiring care, and the amount of care required (e.g. hospitalization days, additional physician's time). Experts were also asked to provide, per type of transfusion reaction, an estimate of the proportion of transfusion reactions preventable. Structured quantitative expert elicitation methods were applied to obtain and combine expert estimates.
The estimated annual in-hospital cost of transfusion reactions in the Netherlands is €933 356 per year (€1.52 per transfusion). Two-thirds (64%) of these are incurred by non-serious transfusion reactions. Circulatory overload, TRALI and anaphylaxis clearly dominate the costs of serious adverse transfusion reactions (66% in total); non-haemolytic transfusion reactions incur 46% of the cost of non-serious transfusion reactions. Additional safety measures targeting circulatory overload and new antibody formation potentially offer the highest cost reduction.
In-hospital costs of transfusion reactions are substantial but contribute to less than 1% of the total cost of transfusion in the Netherlands. A considerable part of these costs (24%) might be preventable.
尽管全球范围内对输血监测报告越来越细致，但仍缺乏对输血反应成本的系统评估。部分原因在于，此类评估需要专家对与不良反应相关的额外成本进行主观评估。输血反应成本的数据有助于支持输血安全措施的决策制定。
邀请了来自9家医院的13名专家，对各类输血反应后所需的额外护理进行估算。额外护理以需要护理的反应比例以及所需护理量（如住院天数、额外的医生诊疗时间）来量化。还要求专家针对每种输血反应类型，估算可预防的输血反应比例。采用结构化定量专家征询方法来获取并整合专家的估算结果。
荷兰输血反应的年度住院成本估计为每年933356欧元（每次输血1.52欧元）。其中三分之二（64%）由非严重输血反应产生。循环超负荷、输血相关急性肺损伤和过敏反应在严重输血不良反应成本中占主导地位（总计66%）；非溶血性输血反应占非严重输血反应成本的46%。针对循环超负荷和新抗体形成的额外安全措施可能带来最高的成本降低。
输血反应的住院成本很高，但在荷兰输血总成本中所占比例不到1%。这些成本中有相当一部分（24%）可能是可预防的。
